Buck's Fascia Research Articles

Role of Long-Chain Cyanoacrylate as an Adjunct Interposition Layer in Repair of Hypospadias and Urethrocutaneous Fistula in Children: A Novel Technique.

Purpose Hypospadias is an anomaly wherein the urethral opening is ectopically located on the ventral aspect of the penis. The most common complications after hypospadias repair are urethrocutaneous fistula (UCF) and meatal stenosis. Long Chain Cyanoacrylate (LCCA) tissue adhesive promises safety, feasibility, and durability due to its tensile strength and bacteriostatic and hemostatic properties. We conducted this study to ascertain whether LCCA tissue adhesive can prove a more effective adjunct to traditional suturing techniques. Methods Patients were divided into two groups. Group A underwent surgery with conventional reconstruction of the neourethral tube along with the buttressing layer using Buck's fascia or Tunica Vaginalis. In addition to the traditional procedure of GroupA, Group B patients were administered a layer of LCCA tissue adhesive as an adjunct between the neourethral suture line and the buttressing layer. Patients were followed up for six months and were evaluated for complications like UCF, meatal stenosis, hematoma, skin infection, glans dehiscence, and flap necrosis. Results Thirty-eight children in the age group 1-6 years were studied, of which 20 were in Group A and 18 in Group B. Among patients of Group A seven (35%)developed complications. In contrast, only four (22.2%)patients developed complications in Group B. The statistical significance in the complication rates between the two groups could not be achieved due to the modest sample size. However, the numerical and proportional reduction in the number of complications was noted. Conclusion LCCA adhesive as an adjunct numerically reduces the number of complications compared to traditional suturing alone in patients undergoing surgery for hypospadias and UCF.

Penile Enhancement Using Biodegradable Scaffolds Covered with Platelet-rich Plasma-Fibrin Glue, Mesenchymal Stem Cells for Micropenis.

Evaluation of preliminary cosmetic and functional outcomes of biodegradable scaffolds covered with platelet-rich plasma in penile girth augmentation. Between June 2016 and June 2018, 36 males who had a mean age of 28.91 years (range 20 - 48 years) with micropenis underwent this procedure. A mixture of platelets-fibrin glue and mesenchymal cells obtained from dermal fat tissue were prepared. Then the mixture was seeded on the pretreated tube-shaped poly lactic-co-glycolic acid scaffold and underwent a whole day of incubation. Following penile degloving, scaffolds were surgically implanted within the interface region of dartos and Buck's fascia. The 5-point Likert scoring scale was used to evaluate the patients' satisfaction with surgery. Patients followed up for 6-12 (8 ± 2.86) months. The penile length in an erected state before surgery was 6.5 - 12.5 cm (9.08 ± 1.6) which enhanced to 7 - 14 cm (10.59 ± 1.71) after surgery (P < .0001). The penile girth before and after surgery were 8.49 ± 1.53 and 10.91 ± 1.96 cm, respectively (P < .0001). An augment in penile length and girth of 1.5 and 2.6 cm were achieved, respectively. Patients appraised surgical intervention on a rating of one to five. The highest possible score (5) was assigned by 27 %, 33 % expressed a very good mark (4), and 19 % gave a good mark (3). Covering the scaffold with a mixture of Platelets-Fibrin glue and mesenchymal cells seems a safe and feasible method for penile reconstruction surgery. More studies should be done to determine the effect of platelets- fibrin glue and mesenchymal cells for treating micropenis.

(216) Benefit of Closed Wound Drainage System with Negative Pressure in Penile Enhancement Surgery

Abstract Introduction Many patients have had penile enhancement surgery and the surgeon try to reduce postoperative complications including hemorrage, infection, wound dehiscence etc. we want to evaluate the benefits of closed wound drainage system with negative pressure in penile enhancement surgery. Objective we want to evaluate the benefits of closed wound drainage system with negative pressure in penile enhancement surgery. Methods We have experienced 500 penile enhancement surgery. We adopted a pre-pubic minimal incision and dissected penile shaft and pre-pubic space. Inserted graft materials were Allograft dermal grafts which were fixed at the Buck's fascia. And we dissected fundi-form ligaments and sutured transversely pre-pubic dead space with PDS 2.0. In group 1, silastic drain were inserted in 250cases in order to drain postoperative bleeding and prevent inflammation. In group 2, the remain 250 cases adopted closed wound drainage system with negative pressure. Results In group 1, the wound infecton rate was 2.9% and no dermal graft infection was showed. In group 2, the wound infection rate was 0.6% and no dermal graft infection was appeared. Group 1 using closed wound drainage system with negative pressure is more effective than group 2 using silastic drain in order to reduce wound infection rate. Conclusions In penile augmentation surgery using Allogenic dermis, Using closed wound drainage system with negative pressure is safer than using silastic drain as postoperative drainage system. Disclosure No.

(217) Report of Surgical Treatment Using Allogenic Dermal Graft Penoplasty to Treat Premature Ejaculation

Abstract Introduction Premature ejaculation is the major factor that causes low satisfaction of sexual intercourse. Ejaculation time is determined by various factors including such as psychological, habitual and physical factors, sensitive penile shaft and glans. Objective This study aimed to report the effectiveness and the safety of newly adopted surgical treatment using allogenic dermal graft. Methods We had performed Dermal graft surgery for treating premature ejaculation in 56 men who have short time ejaculatory problems within 5 minutes on average. We adopted a pre-pubic minimal incision and dissected penile shaft and pre-pubic space. Inserted graft materials were Allograft dermis which were fixed at the Buck's fascia. Glans sulcus was dissected from 8 o’clock to 4 o’clock and the thin strip shaped graft was fixed at the dissected space of glans sulcus. Vibratory sense of glans and penile shaft was estimated by biothesiometry and ejaculatory time was surveyed at both preoperative and postoperative status (5month~18month). Results 48 patients answered that their ejaculatory time was considerably delayed. And 7 patients slightly delayed. Among them, 1 man answered that there was no surgical effects despite of slightly being reduced penis sense. Following being asked raising their frequency of sexual intercourse, 1 man with no surgical effect was considerably improved in delaying the ejaculatory time. Among 136 cases, the inflammation on wound site occurred in 2 patients fully recovered in 2 weeks. No other complication occurred. Conclusions The surgical treatment using allogenic dermal graft is very effective in treating premature ejaculation. And this surgical procedure is very safe without no series complication. Disclosure No.

(169) Penile Fracture and Urethral Injury Repair

Abstract Introduction Penile fracture refers to the rupture of tunica albuginea of the penile corpora cavernosum which most often occur due to trauma during coitus or manual manipulation. This can be associated with either a partial or a complete urethral injury up to 39% of cases, usually those fractures crossing the septum. It is important to address both conditions to ensure sexual and voiding function is maintained. Objective The patient presented in this video is a 35-year-old gentleman who presented to the emergency department post-trauma related to sexual intercourse causing immediate detumescence and swelling. Methods This video describes the penile fracture repair performed using a midline ventral incision repair technique. Prior to surgery the patient is imaged, usually ultrasound, to allow location and marking of the suspected penile fracture. Due to the suspected urethral injury requiring a suprapubic catheter insertion at the presenting hospital, a flexible cystoscopy was performed initially. This showed the urethra was inaccessible at the level of the penile scrotal junction but within the penile urethra. A ventral midline incision along the penile raphe over the suspected fracture site is made. Dartos and Bucks Fascia were dissected to expose the tunica albuginea and allow identification of the fracture site. Further dissection was required to determine the lateral extents of the injury. Stay sutures can then be placed to allow easier closure of the injury. The tunica albuginea was then sutured with PDS sutures, care was taken to ensure these are buried sutures to ensure the patient is unable to palpate these. Subsequently, urethral injury was addressed by performing primary urethral anastomosis. A catheter was introduced through the urethra, a complete transection was seen and the ends were then dissected out to allow an end to end anastomosis to be performed. The anastomosis was checked for a leak with a table urethrogram using dilute betadine. Upon adequate closure of the urethra the ventral midline incision was closed. Results The procedure was successful and uneventful. He has a urethrogram 3 weeks post-op on which no evidence of a leak was shown. This patient went on to have good erectile function at 2 months post-operatively. However, he has a 30-degree ventral curvature which he finds bothersome. This is currently being treated conservatively with a vacuum device. Conclusions The BAUS consensus documents reports erectile dysfunction and penile curvature rates following surgery for penile fracture repair are reported to be 5% and 5% respectively. Conservative management results have a much higher rate of complication with 62% chance of erectile dysfunction and 35% chance of curvature. Disclosure No.

Experience With Extra-Tunical Grafting and Tunica Albuginea Plication for Correction of Indentation Deformity in Men With Peyronie's Disease

To further evaluate extra-tunical grafting (ETG), a relatively new surgical option to treat corporal indentation in those with Peyronie's disease without buckling or hinge effect, we report our experience, patient satisfaction, and surgical outcomes. Retrospective review of patients following ETG, including pre-operative deformity, type of graft, graft location (under or over Buck fascia), patient characteristics, and satisfaction. Overall cosmetic satisfaction with deformity correction between patients undergoing 2 different ETG locations and 3 different types of grafts, as well as perceived bother of graft visibility and palpability were assessed. From 2018-2023, 35 patients underwent ETG and tunica albuginea plication (TAP) with 89.6% of patients having persistent correction on office examination at a median (interquartile range) follow-up of 23.5 (15.2) months. Overall satisfaction with penile appearance by grafting location via patient-reported questionnaires showed no statistical difference (P=.47). Patients undergoing TAP and ETG were satisfied with their erect appearance regardless of graft material. Patients reported grafting tissue was palpable (74.3%) and visible (48.6%) in the flaccid state as compared to the erect state (8.6% and 5.7%). ETG presents a less invasive surgical option than traditional approaches to correct indentation deformities not associated with instability. Our experience shows high patient satisfaction rate following correction of indentation using graft tissue when placed under or over Buck fascia. At a median follow-up of almost 2years, patients had persistent correction, and while some report visibility of the graft and palpability in the flaccid state, this tends to disappear in the erect state.

Topographic and Structural Anatomy of the Suspensory Ligament of the Penis: Implications for Phalloplasty.

The suspensory ligamentous system of the penis supports the penis when erect and plays a key role during coitus. These ligaments, which are prone to injury during coitus, are clinically important in penile reconstruction procedures. The current study investigated the macro- and microanatomy of the suspensory ligamentous system of the penis to determine the origin, course, insertion, dimensions, and tissue composition of these ligaments, knowledge of which is vital for successful penile reconstruction procedures. The study utilized a total of 49 cadavers. Gross anatomy dissection, MRI, and histological staining were performed to elucidate the topography, dimensions, and tissue composition of the suspensory ligaments of the penis. Three ligaments were observed to form the suspensory ligamentous system of the penis. The most superficial is the fundiform ligament, which consists of superficial bundles and deep median bundles, with the former arising from the Scarpa's fascia and the latter arising from the linea alba of the anterior abdominal wall; both inserted into the superficial fascia of the penis. The suspensory ligament of the penis arose from the pubic symphysis and inserted into the deep fascia (Buck's fascia) of the penis. The arcuate ligament arose from the body of the pubis and pubic symphysis and inserted into the Buck's fascia. The ligaments were determined to consist of adipose tissue, collagen fibers, elastic fibers and reticular fibers, in varying proportions. The suspensory ligaments of the penis exhibit a fan-like structure on the penis that allows the forward movement of the penis as a result of engorgement of the erectile bodies while simultaneously offering support.

Modified penile reconstruction in classic bladder exstrophy: Can complete corporal covering of the urethral closure be achieved using incomplete disassembly technique?

To answer the question of whether it is possible to achieve complete corporal covering of the urethral closure using incomplete penile disassembly in classic bladder exstrophy. We hypothesize that mobilization of the corpora under Buck's fascia, their dorsal translocation through the incisions in Buck's fascia and suturing corporal convex sides above the urethra would allow extend corporal covering of the urethra, reducing the risk of urethra-cutaneous fistula formation. A prospective follow-up on all boys who underwent the modified Cantwell-Ransley primary penile reconstruction was conducted. Inclusion criteria comprised bladder exstrophy closure in our institution, ensuring a postoperative follow-up period of no less than 24 months. The key innovation of the technique lies in a deep dissection of the dependent corpora under Buck's fascia, followed by their dorsal relocation through extended dorsal incisions in Buck's fascia, and limited external corporal rotation 90 degrees only at the base of the penis. Between November 2019 and March 2022, 18 boys aged 11 to 35 months met the inclusion criteria and underwent the modified penile reconstruction. Surgical procedures and postoperative period did not include any major complications. Total corporal covering of the urethral sutures was achieved in 15 of 18 patients. No urethra-cutaneous fistulas were observed within 2 years of follow-up. All individuals demonstrated spontaneous erections, and the absence of dorsal curvature was documented. The modified technique of incomplete penile disassembly applied in a homogenous group of patients with classic bladder exstrophy allows penile shaft elongation, improved aesthetic outcomes, preserved erections, and eliminates dorsal curvature. The technique demonstrated feasibility and reliability while maintaining positive effects on tissue circulation. The absence of urethra-cutaneous fistulae is attributed to the complete corporal covering of the urethral sutures and supports the initial hypothesis.

Surgical efficacy of tubularized incised plate urethroplasty applying for Buck's fascia coverage in the treatment of hypospadias

ObjectiveThe aim of this study was to compare the effectiveness of Buck's fascia and dartos fascia in covering the neourethra during tubularized incised plate urethroplasty (TIPU) for treating hypospadias in children. MethodsWe conducted a retrospective analysis of 100 cases of hypospadias treated with TIPU at the Department of Urology, Beijing Children's Hospital from January 2019 to September 2021. The cases were divided into two groups (A and B) based on the type of intraoperative neourethral covering used during surgery. Group A (n = 53) was covered with Buck's fascia, while group B (n = 47) was covered with dartos fascia. Two experienced surgeons performed the surgeries in their respective groups. We recorded general clinical data, intraoperative measurements, and postoperative follow-up data for both groups and analyzed the results statistically. ResultsThere were no significant differences in clinical data, such as mean age, urethral opening position, penile length, urethral plate width, urethral defect length, preoperative penile curvature and follow-up time (P > 0.05) between the two groups. However, group A had a wider glans and a lower proportion of dorsal tunica albuginea plication to correct penile curvature but a higher proportion of 6F catheters left in place (P < 0.05). c, group A reported 12 cases (22.6 %) of complications including eight cases (15.1 %) of urethral stricture and five cases (9.4 %) of urethral fistula; four cases were related to penile corporal fistula while one related to coronal fistula. On the other hand, group B reported 17 cases (36.2 %) of complications including three cases (6.4 %) of urethral stricture and fourteen cases (29.8 %) of urethral fistula; four cases were related to penile corporal fistula while one related to coronal fistula. A multifactorial analysis incorporating confounding factors revealed a lower incidence rate for urethral fistulas in group A compared to group B(P < 0 0.05). ConclusionThe application of Buck's fascia to cover the new urethra can effectively reduce the incidence of urethral fistula in TIPU, and the quality of Buck's fascia and suture tension should be taken into account to avoid the formation of urethral strictures.

(535) A Novel Approach for Penile Venous Stripping Surgery and Bilateral Varicocelectomy on an Ambulatory Basis

Abstract Introduction There are varied approaches for conducting varicocelectomy and penile venous surgery, which are not unified or conspicuously, being not above controversy in the later type either in methodology or routes for accessibility thus far. Objective We sought to present this innovative method in a novel combination of a physiological penile venous stripping and bilateral varicocelectomy via a single longitudinal pubic wound on an ambulatory basis. Methods From July 2012 to December 2021, 63 consecutive patients underwent this combined surgery. Primary diagnosis tools are dual cavernosography and doppler sonography. A 4-5cm longitudinal pubic incision is two-thirds above the penile pubic fold. A blunt dissection maneuver using a hemostat or finger creates a space between the Colles' and Buck's fascia. The entire penis is then released with an inside-out maneuver resulting in Buck's fascia being exposed exclusively, followed by firmed ligation of every emissary vein of the corpora cavernosa via 6-7 open-to-open schemes on Buck's fascia, subsequently stripping of the deep dorsal vein (DDV) and paired cavernosal veins (CVs). In contrast, the para-arterial veins are just ligated segmentally. Reduction of the penis is made after Buck's openings are repaired with not too tight square knots with 6-0 nylon. The stripping of the DDV and CVs is completed after 125-137 ligatures until the infra-pubic angle. Finally, the spermatic cord is hooked below the inguinal canal outlet level. On each side of the varicocele, ligation of 8-11 spermatic veins is macroscopically performed at no expense of ruining all other tissues, even the fragile lymphatic vessel. Then meticulous repair is obtained layer by layer. This novel approach is likely the most appropriate method for making a milking maneuver which is helpful in vascular differentiation on both corpora cavernosa and pampiniform plexus during the entire procedure to prevent residual veins from offensive. Results The average follow-up period is 5.3±0.5 years. There is a significant (9.6±2.7 vs. 20.9±2.3; P&amp;lt;0.01) between the preoperative and postoperative IIEF-5 scores. So does the EHS scale (1.6±0.3 vs. 2.9±0.3; P&amp;lt;0.01) between the preoperative and postoperative status. The radiopacity was unexceptionally enhanced postoperatively. Although the intracorporeal retention and erection quality improvement were unexceptional, the satisfaction rate is just 71.4% (45/63). Penile length resumed 3.5 months postoperatively, although two patients initially complained about 1-2 cm postoperative shortage. Conclusions From the physiology viewpoint, we would like to recommend this promising method with which the shortcut to express. Disclosure No

(414) Double Distal Fixation Stitch

Abstract Introduction Distal cylinder extrusion is not a common complication of penile prothesis surgery when compared to mechanical device failure but can have very serious complications if not addressed properly. Reported revision surgery for IPP implantation is more commonly required for cosmetic and erosion problems as opposed to mechanical failure. Complications such as distal crossovers, delayed distal crossovers, and impending lateral extrusion can be treated with a double distal fixation stitch. This technique addresses stabilization issues and keeps penile implant secure and in place. Objective We demonstrate the Double Distal Fixation Stitch for the meandering distal cylinder Methods 62 y/o white male Hx of erectile dysfunction and Penile implant No significant past medical history Presents with pending left lateral cylinder extrusion Implant functional Patient underwent a corporoplasty and double distal fixation stich in order to ensure distal aspect of cylinder remains in place Results A lateral sub-coronal incision is used on the affected side where cylinder should be positioned. Dissection is carried through the Buck fascia, followed by a transverse incision of the tunica albuginea, where the distal aspect of the affected cylinder is delivered. Two 2-0 Ethibon sutures are threaded through the distal cylinder islet of the implant. A new, properly positioned intracorporal channel is created using a longitudinal capsulotomy and dilation with a 9 Hagar. Two 2-0 Ethibon sutures are passed through the distal islet of the implant cylinder. The first suture is passed through the glans with the cylinder in the native corpora position, a second suture is passed through about .25cm apart from first suture creating a small bridge. A small incision is made connecting the two suture exit sites. Both sutures are then tied down individually leaving one suture on each side to be tied across the bridge. The knots are then buried in the glans by elevating the skin and closing the skin with 3-0 chromic. Conclusions This technique ensured that the cylinder remained in the newly created, appropriately positioned channel. The double distal fixation stitch is safe and effective in securing the distal cylinder of an inflatable penile prosthesis and preventing recurrence. This technique is a useful surgical adjunct to treating patients with prosthetic lateral extrusions or crossovers that can be applied in almost all cases and can ensure distal stabilization of a migrating distal cylinder in weak tunica. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: coloplast, boston scientific.

Analysis of The Curative Effect of Tubularized Incised Plate Urethroplasty for Distal Hypospadias With The Dysplastic Corpus Spongiosum Covering Technique.

To investigate the use of tubularized incised plate (TIP) urethroplasty for distal second- and third-degree hypospadias to free the dysplastic forked corpus spongiosum and Buck's fascia, which are used as a covering material for the new urethra, thereby reducing the incidence of urinary fistula and other complications in the coronal sulcus. Clinical data of 113 patients with distal hypospadias treated with TIP urethroplasty from January 2017 to December 2020 were retrospectively analyzed. The study group comprised 58 patients (use of dysplastic corpus spongiosum and Buck's fascia to cover the new urethra), and the control group comprised 55 patients (use of dorsal Dartos fascia to cover the new urethra). All children were followed up for more than 12 months. In the study group, 4 patients developed urinary fistulas, 4 developed a urethral stricture, and no case developed glans fissure. In the control group, 11 patients developed urinary fistulas, 2 developed a urethral stricture, 3 developed a glans cracking. Using the dysplastic corpus spongiosum to cover the new urethra increases the amount of tissue in the coronal sulcus and reduces the incidence of urethral fistula, but it may increase the incidence of urethral stricture.

Penile squamous cell carcinoma exclusive to the shaft, with a proposal for a novel staging system.

Penile squamous cell carcinomas (SCC) originating in the shaft are rare. pT1/pT2 categories in the American Joint Committee on Cancer (AJCC) staging manual (8th edition) are poorly defined for SCCs arising in the dorsal shaft as anatomic structures differ between the glans and dorsal shaft (corpus spongiosum vs dartos/Buck's fascia, respectively). We reviewed six penile SCC cases exclusive to the shaft, an unusual presentation, identified amongst 120 patients treated with penectomy. We propose a novel pT staging system for dorsal shaft tumors tailored to its anatomic landmarks, where tumors extending to Buck's fascia are considered pT2 instead of pT1. The mean age at penectomy, average duration of follow-up, and mean depth of invasion were 64 years, 45 months, and 9.8mm, respectively. Four cases were moderately differentiated, HPV-negative SCCs of the usual type and two cases were HPV-positive basaloid and warty-basaloid carcinomas. Three cases had nodal or distant metastasis at the time of penectomy, and histologic assessment in these cases showed invasion into the Buck's fascia or deeper. According to the current AJCC system, only one of these three cases would be staged as≥pT2. In contrast, all three metastatic tumors would be staged as≥pT2 in the proposed model. At last follow-up, one patient died of disease-related complications. Based on this limited series, the proposed staging model appears to suggest better patient stratification for pT1/pT2 stages. This model incorporates Buck's fascia, which has been postulated as a pathway of tumor infiltration. Additional studies are needed to validate this model.

MP36-09 EXPERIENCE WITH EXTRATUNICAL GRAFTING (ETG) FOR CORRECTION OF INDENTATION DEFORMITY WITHOUT BUCKLING IN MEN WITH PEYRONIE’S DISEASE

You have accessJournal of UrologyCME1 Apr 2023MP36-09 EXPERIENCE WITH EXTRATUNICAL GRAFTING (ETG) FOR CORRECTION OF INDENTATION DEFORMITY WITHOUT BUCKLING IN MEN WITH PEYRONIE’S DISEASE Jose Quesada-Olarte, Spencer Mosack, Daniel Roadman, and Laurence Levine Jose Quesada-OlarteJose Quesada-Olarte More articles by this author , Spencer MosackSpencer Mosack More articles by this author , Daniel RoadmanDaniel Roadman More articles by this author , and Laurence LevineLaurence Levine More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003270.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peyronie's Disease (PD) can be surgically challenging, especially in men with indentation deformity. Extratunical grafting (ETG) is a relatively new surgical option that be employed to treat corporal indentation in those without buckling or hinge effect. Objective: To report our experience with the ETG procedure, including different grafts or graft location (under or over Buck’s fascia) pre and post-operative patient characteristics, and patient satisfaction. METHODS: We performed a retrospective chart review of patients following ETG, collecting data including baseline demographics, prior treatments, pre-operative deformity, erectile function, type of graft, grafting location (under or over Buck’s), patient satisfaction, and clinical outcomes at our tertiary-care referral center. RESULTS: From December 2018 to July 2022, 33 patients presenting with PD underwent an ETG and TAP and/or PEG (partial plaque excision and grafting) for indentation deformity with a mean follow-up of 14.6 months. Overall, patient satisfaction, specifically for the correction of indentation was 94%. Grafting location under or over Buck's fascia showed no statistical difference in patient satisfaction with penile appearance (54.5% and 72.7%, respectively, p>=0.05). Patients undergoing ETG, with PEG had significantly lower satisfaction with their erect appearance than TAP and ETG (0% and 71.4%, respectively, p=0.003). Several different grafts were used, there was no difference in satisfaction between the grafts used. Palpable graft was reported in 30 patients (91%), but only two were bothered by the graft (6%). Statistical analysis showed no difference in patient satisfaction according to the size of the graft or degree of curve correction. CONCLUSIONS: ETG has emerged as a less invasive and less risky surgical option than PEG to correct indentation deformities which are not associated with buckling or axial instability. Our initial results demonstrate a high rate of satisfaction with correction of indentation, but multiple factors contributed to lower overall satisfaction with appearance of the penis including loss of length (9%), residual curvature (6%), sensory changes (9%), and erectile dysfunction (15.1%). Further studies are needed to determine the optimum approach. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e482 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jose Quesada-Olarte More articles by this author Spencer Mosack More articles by this author Daniel Roadman More articles by this author Laurence Levine More articles by this author Expand All Advertisement PDF downloadLoading ...

Spongioplasty with Buck's fascia covering dorsal inlay graft urethroplasty for primary hypospadias repair

Neourethral covering is an essential technique for preventing complications such as fistula and glans dehiscence in hypospadias repairs. The spongioplasty has been reported for neourethral coverage about 20 years ago. However, reports of the outcome are limited. This study aimed to retrospectively evaluate the short-term outcome of spongioplasty with Buck's fascia covering dorsal inlay graft urethroplasty (DIGU). From December 2019 to December 2020, 50 patients with primary hypospadias (median age at surgery, 37 months; range, 10 months-12 years) were treated by a single pediatric urologist. The patients underwent spongioplasty with Buck's fascia covering dorsal inlay graft urethroplasty in single stage. The penile length, glans width, urethral plate width and length, and the location of the meatus of the patients were recorded preoperatively. The patients were followed up,complications noted, and postoperative uroflowmetries at the one-year follow-up time were evaluated. The average width of glans was 12.92±1.86mm. A minor penile curvature was observed in all patients (≤30°). The patients were followed up for 12-24 months, and 47 patients (94%) were free from complications. A neourethra formed with a slit-like meatus at the tip of the glans, and the urinary stream was straight. Three patients had coronal fistulae (3/50) and no glans dehiscence, and the mean±SD Qmax of postoperative uroflowmetry was 8.13±3.8ml/s. This study estimated the short-term outcome of the DIGU covered using spongioplasty with Buck's fascia as the second layer in patients diagnosed with primary hypospadias with a relatively small glans (average width <14mm). However, only a few reports emphasize spongioplasty with Buck's fascia as the second layer and the DIGU procedure performed on a relatively small glans. The major limitations of this study were its short follow-up time and the retrospective data collection. Dorsal inlay graft urethroplasty combined with spongioplasty with Buck's fascia as coverage is an effective procedure. In our study, this combination had good short-term outcomes for primary hypospadias repair.

Two levels vs. one level of phallopexy in the treatment of concealed penis in patients in pediatric age group.

Concealed penis, which is the congenital type of buried penis, is a condition in which a normal-sized penis is totally or partially hidden by pubic, scrotal, or thigh skin. Several procedures had been described for its correction including phallopexy, that is, fixation of penile Buck's fascia to the sub-dermis. Our work aims to study the difference in outcome between performing phallopexy at one level and at two levels. Our study included 180 uncircumcised patients who had a concealed penis while having an average length of an outstretched penis. These patients were divided into two groups: the first one was treated with one level of phallopexy at the 3 and 9 o'clock points, while the second group was treated with the same procedure in addition to another level of stitches at the mid-penile level. The follow-up was carried out for one post-operative year regarding penile skin edema, infection, congestion, necrosis, and/or re-retraction. The overall success rate was 96.1% for a normally-looking penis without post-operative re-retraction. Re-retraction developed in two patients (2.2%) of those who had one-level phallopexy and in five patients (5.6%) of those who had two-level phallopexy without statistical significance (FE p = .444). Penile skin edema developed in 76 patients (42.2%) being significantly lower in patients with lower body weight (p = .030*). Phallopexy could be performed safely in the case of the concealed penis with satisfactory results. Two levels of phallopexy did not add any advantage to the post-operative results besides the fact that this may be demanding, time-consuming, and may require higher resources, so we recommend the easier one-level phallopexy in the treatment of such conditions with satisfactory results.

Concealed penis in pediatric age group: a comparison between three surgical techniques

BackgroundComparison between three different surgical techniques in the management of concealed penis.MethodsThis prospective interventional non-randomized study included 150 pediatric patients with a concealed penis. They were distributed equally into three groups; group A; patients treated by anchoring the penile skin dermis to Buck's fascia at the penile base at 3 and 9 o'clock points using PDS 5/0 (phallopexy), group B; patients treated by complete dissection and excision of dartos fascia and group C; patients treated by phallopexy as in group A after complete dissection and excision of dartos fascia. Follow-up at the end of the 1st post-operative week and then monthly for 6 months as regards penile skin congestion and/or necrosis, wound infection, edema, and/or re-retraction was carried out.ResultsPenile edema and re-retraction have a statistically significant difference among the studied groups (p < 0.001 and p = 0.002 respectively). Penile re-retraction was noticed to be lowest in patients of group C, however penile edema was observed to be highest in patients of group B.ConclusionsPhallopexy after complete dissection and excision of dartos fascia have better results than doing either phallopexy or dartos excision alone in the treatment of concealed penis.Clinical trial registration: The manuscript was registered in ClinicalTrials.gov Protocol Registration and Results System. ClinicalTrials.gov Identifier: NCT05565040. Our manuscript was registered on 4/10/2022.

Application of a free preputial tube graft coupled with urethral plate urethroplasty combined with a Buck's fascia integral covering for the single-stage repair of severe hypospadias.

To assess the outcome of a free preputial tube graft coupled with urethral plate urethroplasty combined with a Buck's fascia integral covering (BFIC) for the single-stage repair of severe hypospadias in children. A retrospective study was performed on 40 children with hypospadias who were treated in our hospital from December 2017 to February 2022. The inclusion criteria were as follows: (1) the patient had proximal hypospadias, or penile curvature over 30° after degloving the penis; and (2) the patient underwent surgery for hypospadias for the first time. A free preputial tube graft coupled with urethral plate urethroplasty combined with a Buck's fascia integral covering was performed, and all patients were followed up for more than 6 months. After degloving the foreskin, the urethral orifice was retracted to the perineum and scrotum in 20 cases, penoscrotal in 8 cases, and penile in 12 cases. Single-stage repair was achieved without complications in 34 (85%) patients. The remaining six patients experienced postoperative complications: urethrocutaneous fistula occurred in five cases and glans dehiscence with urethrocutaneous fistula in one case. No urethral diverticulum occurred in any case. A neomeatus with a vertically oriented slit-like appearance was achieved at the tip of the glans in all cases, with one exception. The single-stage operation with a free preputial tube graft coupled with urethral plate urethroplasty combined with a Buck's fascia integral covering in the treatment of severe hypospadias achieves favorable functional and cosmetic outcomes.

Scrotal approach for tunica expansion procedure (TEP) for penile girth and length restoration during penile prosthesis implantation in patients with penile angulation due to Peyronie's disease and erectile dysfunction: technique and outcomes.

Peyronie's disease is often comorbid with erectile dysfunction and can cause significant penile shortening. We describe our modified tunica expansion procedure (TEP) technique of penile length preservation and girth enhancement with correction of penile angulation in patients with mild Peyronie's disease (<30 degree angulation, or hourglass deformity, no hinging) and erectile dysfunction presenting for inflatable penile prosthesis (IPP) surgery. A retrospective review of IPP placement from one high volume surgeon was performed. A total of 474 patients' charts from June 2017 to June 2021 were reviewed and those charts of patients undergoing modified TEP in the setting of Peyronie's disease were analyzed. Average increase in length and girth were measured and means with standard deviations calculated. The modified TEP is performed through a scrotal approach and involves complete eversion of the penis with dissection of Buck's fascia off the underlying tunica. Subsequently, staggered scorings of the underlying tunica are performed allowing for circumferential girth enhancement and length preservation. In men with Peyronie's disease, these scorings are preferentially concentrated on the side of the plaque to allow straightening without loss of length. A total of 32 patients with Peyronie's disease from the larger cohort underwent the modified TEP. Mean increase in length of distal corpora was 2.8 ± 0.8 cm (range 2.0-3.4 cm) (measured using Furlow before and after penile eversion with TEP), while mean increase in girth (measured at midphallus prior to prosthesis insertion and after IPP inflation) was 1.6 ± 0.4 cm (range 1.2-2.2 cm). There were no reported complications. A scrotal approach to TEP is an easy to perform technique that can be used to restore length and enhance girth in men with Peyronie's disease undergoing insertion of IPP. Additionally, it is a customizable approach that can also be used to correct mild penile angulation.

Preliminary Application of a Novel Autologous Scrotal Dartos Flap Method for Enlargement of Penile Girth in Men with Small Penis Syndrome.

Augmentative phalloplasty is a controversial issue. A safe, stable, and efficient surgical method for penile girth enlargement has not been available. This article introduces a novel autologous scrotal flap-turning procedure, the scrotal dartos flap method, for men with small penis syndrome and addresses its efficacy and safety. A single-center, prospective study was conducted at the Zhongnan Hospital of Wuhan University, where 29 patients were treated with the scrotal dartos flap method. The key procedure for this technique is fully turning the scrotal dartos flap to the loose plane just between the superficial penile fascia and the Buck fascia to increase the circumference of the penis. Penile girth improvement and adverse events were recorded. Complete follow-up data were collected for 27 of 29 patients (93.1 percent). It yielded a girth improvement of 3.59 ± 0.80 cm (50.8 percent). This enlargement surpassed that of most previous published surgical procedures. In addition, there were no serious adverse events (e.g., penile fibrosis, flap infection, sclerosis, or removal) during the 6-month follow-up. Wound infection ( n = 1), hematoma ( n = 2), and folding ( n = 1) were all slight. This novel autologous flap-turning procedure performed better than the majority of previously published penile girth enlargement methods and was accompanied by only slight and acceptable adverse events. The scrotal dartos flap method appears to be a viable method for the penile girth enlargement treatment of small penis syndrome. Therapeutic, IV.